Cystogastrostomy as an alternative treatment for recurrent huge infected hepatic cyst

A 73-year-old woman with a history of polycystic liver and kidney disease (PLKD) presented with coffee grounds emesis, hypotension, and acute on chronic renal failure. She developed septic shock and a decline in renal function, necessitating emergency hemodialysis after admission. She had undergone robotic fenestration of a large hepatic cyst 5 months earlier because of acute cholangitis resulting from compression of the common bile duct by the cyst. Esophagogastroduodenoscopy revealed duodenal ulcer and lumen narrowing at the second portion of the duodenum ([Fig. 1] a). Magnetic resonance cholangiopancreatography confirmed a recurrent huge hepatic cyst at segment IV of the liver with air-fluid level ([Fig. 1] b).